Erlangen – The chances of surviving a serious illness from COVID-19 have increased over the past year. This is shown by the results of a medical informatics initiative by 14 German university hospitals, which will soon be in Anaesthesiology and Intensive Care Medicine to be published. Doctors attribute the decline in the death rate to increasing experience with the disease and improved therapy.
Treatment at a maximum-care clinic with a sufficient number of ventilation places and the option of extracorporeal membrane oxygenation (ECMO) does not guarantee that you will survive a severe COVID-19.
In the first months of the epidemic (through April 19), 20.7% of COVID-19 patients died at university hospitals. The proportion of ventilated patients was as high as 39.8%. In the months thereafter (up to September 18), however, there was a decrease to 12.7% in total mortality and to 33.7% in ventilated patients.
At the 14 clinics, 1,318 patients were treated with COVID-19 over the entire period. Of these, 490 patients (37.2%) were ventilated, in 124 patients (9.4%) an ECMO was performed (of which 58 patients could be saved). Hemofiltration, hemodialysis, or hemodiafiltration was necessary in 17.5% of patients. This was particularly the case with ventilated patients.
The most common comorbidities in the patients were renal insufficiency (35.2%), anemia (26.0%) and diabetes mellitus (21.1%). In 10.1% of the patients there were disorders involving the immune system.
The most important risk factor for a fatal outcome is age. The mean age of all COVID-19 patients was 61.2 years. The ventilated patients were on average 63.7 years old and the deceased patients 71.2 years old.
The male gender is also a risk factor: the proportion of male COVID-19 patients was 63.4 percent, 74.9 percent of ventilated patients were male, and 72.6 percent of those who died.
The team around Jürgen Schüttler, Director of the Anaesthesiological Clinic at the University Hospital Erlangen, connects the decline in the mortality rate with increasing knowledge about the pathophysiology, the course of the disease and the treatment options.
The RECOVERY study had shown in mid-June 2020 that treatment with dexamethasone reduced the mortality of patients requiring ventilation. The results were quickly incorporated into the S1 guideline of the AWMF in Germany. According to Schüttler, the gain in knowledge about anticoagulation therapy in COVID-19 patients could also have had an influence.
The treatment results are in line with international experience. Death rates have also fallen in other countries. Doctors from New York seem to be particularly successful.
Leora Horwitz of New York University recently reported to the Journal of Hospital Medicine (2021; DOI: 10.12788 / jhm.3552) a decrease in the mortality rate from 25.6% in March to only 7.6% in August. The exceptionally good numbers could, however, also be related to a decrease in age from 63 to 49 years and the proportion of comorbidities from 80.7% to 71.6%. © rme / aerzteblatt.de